After hysterectomy for benign disease, complications more common with endometriosis

SAN DIEGO — Among women undergoing hysterectomy for benign indications, those with endometriosis had a higher rate of postoperative complications compared with women without endometriosis, according to a presentation here.

“The clinical implications of this study are that patients should be informed about and aware of — and surgeons should be aware of and prepared for — this increased risk when planning surgery for patients with suspected endometriosis,” Emily Wang, MD, an assistant instructor in the department of OB/GYN at the University of Texas Southwestern Medical Center in Dallas, told Healio.

Wang and colleagues used data from 127,556 patients undergoing elective hysterectomy for benign disease who were included in the American College of Surgeons National Surgical Quality Improvement Program databases from 2014 to 2019. They compared the incidence rates of 30-day mortality, postoperative complications and reoperations in patients with and without endometriosis.

Within the study population, 19,618 (15.4%) women had endometriosis. These women tended to be younger; more commonly had pelvic inflammatory disease and prior abdominal operations; and less often had chronic comorbidities, according to the study.

Women with endometriosis had significantly greater odds of having postoperative complications compared with women without endometriosis (9.3% vs. 8.4%; OR = 1.12; 95% CI, 1.05-1.2).

Emily Wang

“Although patients who undergo hysterectomy for endometriosis may be younger and have a lower BMI — both protective factors when generally predicting the risk of perioperative complications — patients who had endometriosis at the time of their hysterectomy had significantly longer surgical times, experienced increased major postoperative surgical complications and had a higher 30-day readmission rate as compared with patients who did not have endometriosis at the time of hysterectomy,” Wang said.

There were no significant differences between the groups for 30-day mortality (0.04% vs. 0.03%) or reoperations (1.5% vs. 1.36%).

“It would be interesting to examine the effect of endometriosis on perioperative outcomes for patients undergoing fertility and uterine-sparing surgical management,” Wang said. “We also hope to examine the impact of surgeon factors like fellowship, training and annual surgical volume on outcomes. Finally, we would like to see if other factors like race, site of service and socioeconomic factors impact these outcomes.”